Southern Manitoba hospital did nearly 30% more hips, knees last year due to new same-day surgeries: doctor

A southern Manitoba hospital was able to churn out close to a third more hip and knee replacements than expected thanks to the introduction of a same-day surgery system supported through funding from the provincial backlog task force.

Boundary Trails Health Centre, located between Morden and Winkler southwest of Winnipeg, did 639 of the procedures in 2022-23 — 139 above its target, according to a provincial announcement at the facility Monday morning.

"I have seen firsthand how this transformation of services has positively impacted the lives of our patients," Boundary Trails orthopedic surgeon Dr. Hany Asham said at the announcement. 

"Same-day surgery enabled us to expand our program that significantly improved patient mobility and allowed them to recover safely in their own homes."

Overshooting its target of 500 surgeries was a result of collaboration between units and workers, said Asham.

It was also a product of funding support from Manitoba's pandemic surgical and diagnostic backlog task force, executive director David Matear said.

"Demand for hip and knee replacement is growing partly due to our aging population, and of course the pandemic increased the wait list numbers," Matear said.

"What happened next was innovation borne out of necessity, because facilities across the province were able to start offering same-day or outpatient hip and knee surgery."

He said focusing more on same-day surgeries is a growing trend in Canada and is also a focus of the task force in Manitoba. 

One reason same-day surgeries appeal to patients is because they allow them to recover safely at home, Matear said.

That also frees up in-patient care beds for other acute patients, he said, and upping same-day procedures may also offer people care options closer to home.

Matear said 10 per cent of the roughly 6,000 hip and knee replacements done on Manitobans in 2022-23 were same-day, something the province hopes to up to 50 per cent "in the next couple of years."

Other hospitals starting similar revamps

Boundary Trails' revamped approach to orthopedic surgery may serve as a test case for getting other institutions in the province closer to that goal. 

Dr. Ed Buchel, provincial surgery lead for Shared Health, said Boundary Trails demonstrated recently through some modifications that it can already do about half of its hip and knee surgeries as same-day procedures.

Grace and Concordia hospitals in Winnipeg are in the building phase of their own similar revamps, said Buchel, who also serves on the provincial task force.

Buchel said the goal in surgical medicine is to minimize the impact on patients, preferring less invasive treatments that get people back into the community and integrated back into their lives.

That's part of the "targeted practice improvement plan" started by Shared Health a couple years ago, said Buchel.

When the COVID-19 pandemic started, surgeons at Boundary Trails led the initiative through patient evaluations, trying to find ways where they could optimize recovery and converting them from a one- or two-day stay to an outpatient, he said.

That required re-engineering how the hospital and health-care professionals treated patients, said Buchel. It hinged on acknowledging not all patients are the same and that some need more or less in-hospital support, he added.

'It's better care'

Now, after select orthopedic surgeries at Boundary Trails, it facilitates an early rehabilitation plan with physiotherapists who meet with patients right after surgery. If it's safe to do so, the patients are released and virtual programs are used to monitor their progress, said Buchel.

The same-day approach, he said, is also cheaper "but more important, it's better care."

"The added advantages of anybody going home [after] surgery is complications exist in hospitals, because they're surrounded by people that are sick," he said.

"We want you home … as soon as you can be at home safely. People do better recovering at home with their family and their loved ones around them. That is the goal."

Buchel said the province still needs more post-surgery rehabilitation capacity. He said Boundary Trails has already submitted a proposal to the province for enhanced recovery programs, increased physiotherapy and augmenting day surgery capacity.

Manitoba Health Minister Audrey Gordon lauded the health-care team at Boundary Trails and said it's an example of provincial attempts to chip away at the overall pandemic surgery backlog.

She also pointed to a previously-announced $64.4 million in provincial funding in 2021 for facility expansions at Boundary Trails to suggest the province is responding to health-care system challenges.

That expansion will add acute care in-patient beds to the facility and a larger space for in-patient programs, the province said.

Manitoba has also struck short-term agreements with private clinics in surrounding jurisdictions to take Manitobans in for hip, knee and other surgeries as a means of eliminating the backlog. Several other provinces have done the same.